Wellcare Patriot Simple (HMO)

Wellcare Patriot Simple (HMO), plan H5294-014-000, is a 2027 Medicare Advantage plan from Wellcare, sold in Texas. Its $3,400 in-network out-of-pocket limit is the lowest of the plans we compared in Bexar County.

This is an HMO plan, so it pays for your care when you use a provider in its network. Outside the network you generally pay the full cost yourself, and the exceptions are emergency care and urgently needed services, which are covered anywhere in the country. You pick a primary care provider from the network, and that doctor coordinates the rest of your care.

You need a referral from your primary care provider before you see a specialist.

To join, you need Medicare Part A and Part B and you have to live in the plan's service area, which covers 51 counties in Texas for 2027. You keep paying your Part B premium to Medicare.

Counties in the service area include Armstrong, Atascosa, Bailey, Bandera, Bexar and Blanco.

In network, a primary care visit is $0, a specialist visit is $10, the emergency room is $150 and urgent care is $25. Emergency care and urgently needed services are covered whether or not the provider is in the plan's network, which matters when you are away from home.

An individual mental health visit is $0 and occupational therapy is $10.

Physical therapy and speech therapy are covered too, at cost shares the plan lists in its Summary of Benefits rather than in the CMS benefit files, so check those two there.

You pay $0 for the preventive services Original Medicare covers when you use a provider in the plan's network. That includes your annual wellness visit, the recommended screenings for your age, and most vaccines. Preventive care is the easiest value to collect from any Medicare Advantage plan, so book the wellness visit early in the year.

Beyond what Original Medicare covers, this plan includes $3,000 a year toward comprehensive dental work, $300 toward glasses or contacts and $750 toward hearing aids. These allowances almost always have to be used with providers and suppliers the plan works with, so check that before you buy, particularly for hearing aids where the plan usually names its own vendor.

The eyewear allowance covers eyeglasses or contact lenses, and it resets each plan year rather than rolling over, so an unused allowance is lost at the end of December.

This plan does not include Part D prescription drug coverage. Most people who choose a plan like this already have drug coverage somewhere else, usually through the VA, TRICARE or a former employer, and that coverage is often creditable, which means keeping it protects you from a late enrollment penalty later.

If you do not have creditable drug coverage, that penalty is the thing to understand before you enroll: it is added to your Part D premium for as long as you have Part D, not just for one year. Whether you can add a separate drug plan while you are on this plan depends on the plan type, so have a licensed agent confirm it for this one rather than assuming.

Some care on this plan needs prior authorization, which means Wellcare has to approve it before you get it. Specialist services are among those that do. Your doctor's office usually files the request, but the plan may not pay if the approval is skipped, so confirm it is in hand before a scheduled procedure. The plan's evidence of coverage lists every service that needs it.

Here is how Wellcare Patriot Simple (HMO) sits against other plans sold in Bexar County for 2027.

This plan has the lowest in-network out-of-pocket limit of the group at $3,400. Humana Gold Plus H4461-053 (HMO) rates higher at 4.5 stars.

This plan may fit people in the service area who want a lower ceiling on a bad year, which here is $3,400. It suits you less well if you want to use doctors outside the network, because this type of plan generally will not pay for that.

Like any Medicare Advantage plan, it changes how your Medicare claims are paid. If you travel often, or you want to use any doctor who accepts Medicare without checking a network, compare it against Original Medicare with a Medicare Supplement and a separate drug plan before you decide.

A licensed insurance agent can check all of these against your own doctors and prescriptions at no cost.